It appears that you are currently using Ad Blocking software. What are the consequences? Click here to learn more.

The Medicare Mystery

By David Mendosa

Last Update: December 10, 2004

Dealing with the government is often difficult. Dealing with the federal government’s complex Medicare program can be even worse. It is one of the biggest challenges for people seeking coverage of diabetes supplies and services.

Medicare sets low test limits

“People have a hard time with Medicare,” says Tim Cady, the president of Advanced Diabetes Supply, a division of North Coast Medical Supply in San Diego. Tim should know, because his national mail order diabetes company specializes in helping people who have Medicare insurance get their testing and insulin pump supplies. The company is on the Net at northcoastmed.com.

Medicare is the nation’s largest health insurance program, covering about 40 million people. You are probably eligible for Medicare if you are disabled, have reached your 65th birthday, or have permanent kidney failure treated with dialysis or a transplant. If it is an enigma that you haven’t unraveled, this column can help.

Generally, Medicare will pay 80 percent of the cost of testing supplies. Your supplemental insurance, if any, will usually pay most, if not all, of the 20 percent balance.

Medicare is difficult now, but for most of us it was impossible six years ago. In July 1998 Medicare expanded coverage of blood glucose meters and test strips for all people with diabetes. Earlier, it covered blood glucose monitors and test strips only for insulin- dependent diabetes.

Medicare will cover everything you need to test — the meter itself, strips, even lancets, control solution, and batteries for your meter. You can get a new lancing device every six months and a new meter every five years.

But Medicare sets some low test limits. If you use insulin, the standard limit is 100 test strips and lancets every month. If you don’t use insulin, the standard limit is 100 test strips and lancets every three months.

The government must think that we test for the fun of it. Three tests a day when you use insulin and just once a day if you don’t is far less than many of us need.

Well written prescriptions can, however, get you what you need. They can’t say “test once or twice a day.” To Medicare that would mean once a day.

When you need to test more often than Medicare’s limits, the prescription also has to give specific reasons. These reasons can include fluctuating blood glucose, uncontrolled blood glucose, hypoglycemia, hypertension, and an adjustment in your medication.

Aside from glucose testing, Medicare coverage for people with diabetes includes therapeutic shoes, eye exams, A1C tests, self-management training, nutrition therapy, and insulin pumps. In fact, the only way to get Medicare to pay for your insulin is to use a pump.

But mysteriously Medicare does not cover syringes, pens, jet injectors, or any diabetes drugs. Let’s hope this will be a holiday present to those of us with diabetes in the next few years.

Sidebar:
Where to Get Answers

Q. Where can I find the government’s own regulations to argue my case?
A. The Internet has two excellent resources:

1. “The Official U.S. Government Site for People with Medicare” is on the Internet at medicare.gov. Search for “Medicare Coverage of Diabetes Supplies and Services.”

2. Medicare’s detailed regulations are on the websites of each of Medicare’s four Durable Medical Equipment Regional Carriers. Each of these DMERCs have the same regulations, and the easiest to find and use is that of Palmetto Government Benefits Administrators at palmettogba.com. Search for “Chapter 38 - Home Blood Glucose Monitors.” It is the first link returned. 


This article originally appeared in Diabetes Health, December 2004, page 64.

[Go Back] Go back to Home Page

[Go Back] Go back to Diabetes Directory

Advertisment
Never Miss An Update!
I comply with the HONcode standard for trustworthy health information. You can verify my HONcode certificate here.